摘要
目的 :模拟生理性消化期及消化间期神经与体液条件 ,观察家兔胆肠吻合术前后胆管和 Oddi括约肌 (SO)动力的变化。方法 :将 35只家兔随机分为对照组和实验组共 5组。实验组则分别静脉注射胆囊收缩素 CCK 10 ng/kg、胃动素受体激动剂红霉素 10 mg/kg、迷走神经抑制剂阿托品 3μg/kg和一氧化氮合成酶抑制剂 L - NAME 10 mg/kg。于家兔十二指肠对系膜缘插孔 ,经乳头逆行插入测压导管 ,采用低顺应性毛细管灌注系统测压。每组在测压完成后将胆囊与空肠上段吻合 ,关腹饲养 1周后重复测压。结果 :行胆囊空肠吻合术后 SO基础压明显增高 ,而收缩幅度降低 ,收缩时间缩短 ,但收缩频率无明显改变。 L - NAME、CCK、红霉素均有兴奋 SO的作用 ,分别表现为基础压和收缩幅度、收缩频率的改变。但与吻合前相比 ,胆囊空肠吻合后增大的幅度降低了。结论 :SO的紧张性收缩与自发性收缩均受神经与体液因素的调节 ,胆囊空肠吻合与引流可引起 SO紧张性收缩增强 ,而使自发性收缩减弱 ,若对 Oddi括约肌功能障碍 (SOD)患者施行胆肠吻合术 ,可能无法缓解临床症状 ,故应慎重选择其手术方式。
Purpose: The study simulates physiological neuronal and hormonal conditions during digestive and interdigestive periods, identifies the changes of the motility of biliary system including bile duct and sphincter of Oddi before and after cholecystojejunostomy. Methods: Thirty five rabbits were divided into five groups randomly. The experimental groups were administrated respectively with CCK 10 ng/kg, erythromycin 10 mg/kg, atropin 3 μg/kg and L NAME 10 mg/kg, which were injected venously. Every rabbit was performed manometry through introducing a three lumen catheter via papillary orifice retrogradely, using the low compliance papillary infusion system. Then anastomosed the gallbladder and the upper segment of the jejunum, repeated the manometric procedures after one week. Results: SO basal pressure increases, contraction amplitude decreases, contraction time shortens after cholecystojejunostomy. L NAME, CCK and erythromycin all can excite SO, respectively increases basal pressure and contraction amplitude, basal pressure and contraction amplitude and frequency, contraction amplitude. But compared with before cholecystojejunostomy, the increasing extent decreases. Conclusion: The tensional and spontaneous contractions of the sphincter of Oddi are in the control of the neural and hormonal mechanism. The anastomose of gallbladder and jejunum and the drainage of bile make the tensional contraction stronger, but the spontaneous contraction weakens after the operation, because the sensitivity of SO to hormonal factors decreases. The clinical symptoms may not be relieved when the SOD patients accepted cholecystojejunostomy and surgeons should carefully choose.
出处
《临床消化病杂志》
2001年第4期149-157,共9页
Chinese Journal of Clinical Gastroenterology
